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Cephalosporin use increases risk for pediatric C.difficile-associated diarrhea
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A recent study found that the risk for community-associated cases of Clostridium difficile-associated diarrhea in pediatric patients may be increased by the use of cephalosporin and gastrointestinal feeding tubes.
“Antibiotic or gastric acid suppressant exposure, gastrointestinal feeding devices, and certain medical conditions, such as malignancy and inflammatory bowel disease, are recognized to be associated with [C. difficile-associated diarrhea (CDAD)] in children,” Jonathan D, Crews, MD, MS, of the Children’s Hospital of San Antonio, Texas, and colleagues wrote. “We found that recent cephalosporin use posed the greatest risk for [community-associated (CA)]-CDAD in children. Gastrointestinal feeding devices were also associated with pediatric CA-CDAD.”
The researchers studied a cohort of 69 pediatric patients, aged 1 to 18 years, who tested positive for CA-CDAD. They compared this group with two control groups of children who had community-associated diarrhea, but tested negative for C. difficile.
Seventy-three individual cases of C. difficile were identified in the patients who tested positive for CA-CDAD. The use of antibiotics was more likely in the patients who had C. difficile infection compared with the patients without C. difficile (40.6% vs. 27.5%). The researchers found that cephalosporin was the antibiotic most significantly linked to CA-CDAD (OR = 3.32; 95% CI, 1.1-10.11).
The researchers also found that use of gastrointestinal feeding devices greatly increased the chances for CA-CDAD (OR = 2.59; 95% CI, 1.07-6.3). Although no mechanism for the relationship between feeding devices and C. difficile infection was identified, the researchers posit that tube feeding possibly disturbs the intestinal flora or allows bacteria to bypass the defense mechanisms in the stomach and oropharynx.
Cases of community-associated C. difficile-associated diarrhea also were found to have an increased presence in children who had visited an outpatient clinic within 30 days before infection. Outpatient visits were associated with 66.7% of children infected with C. difficile, while 48.6% of children in the control group had visited a doctor’s office or clinic (P = .01).
“Reduction in the use of outpatient antibiotics may decrease the burden of community-associated C. difficile-associated diarrhea in children,” Crews and colleagues wrote.
Disclosure: The researchers report no relevant financial disclosures.
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